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Gen Med: Surgery > Fluid Balance > Flashcards

Fluid Balance Flashcards

1
Q

What is the body’s fluid balance dependent on?

A

Homeostasis is dependent on fluid, electrolyte, & acid-base balance

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2
Q

What can disrupt fluid balance?

A
  1. Surgery
  2. Illness
  3. Injury
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3
Q

How is fluid gained?

A
  1. GI tract
    A. Food
    B. Liquids
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4
Q

How is fluid lost?

A
  1. Skin
  2. Lungs
  3. Intestines
  4. Urinary tract
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5
Q

What are the body fluid compartments?

A

Total body fluid (TBF) = extracellular fluid (ECF) + intracellular fluid (ICF)

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6
Q

Define ICF

A

Fluid w/in individual cells of body

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7
Q

Define ECF

A

All body fluids NOT contained in cells

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8
Q

What are the subcategories of ECF?

A

Includes intravascular & interstitial fluid

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9
Q

Define intravascular fluid

A

Fluid w/in plasma & lymph system

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10
Q

Define interstitial fluid

A

Fluid in tissues that fills spaces between cells

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11
Q

Define hypovolemia

A
  1. Low blood volume
    A. Body loses both water & electrolytes from ECF
    B. ↓ Plasma / ↓ Na
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12
Q

Define dehydration

A
  1. Water loss w/out accompanying electrolyte loss

A. ↑ K /↑ Na

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13
Q

What can cause hypovolemia?

A 
1. Abnormal GI loss
A. V/D/NG 
2. Abnormal renal loss
A. Diuresis/DI, Addison’s Dz
3. Plasma loss (3rd spacing)
A. Peritonitis, intestinal obstruction, ascites, burns, vasodilation w/edema
4. Blood loss
A. Int. or ext. hemorrhage
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14
Q

What can cause dehydration?

A
  1. Hyperventilation
  2. DKA
  3. Insufficient water intake
  4. Abnormal skin loss
    A. Diaphoresis
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15
Q

How does the body compensate for fluid loss?

A
  1. Sympathetic Nervous System
    A. Increased thirst
    B. ADH release
    C. Aldosterone release
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16
Q

What are the sxs of hypovolemia?

A
  1. Dizziness/faint
  2. Confusion
  3. Weakness
  4. Fatigue
  5. Nausea
  6. Thirst
  7. Tachycardia
  8. Tachypnea
  9. Hypotension
  10. Oliguria
  11. Orthostasis
  12. Poor cap refill
  13. Pallor
17
Q

What are the sxs of dehydration?

A
  1. Thirst
  2. Headache
  3. ↓ Appetite
  4. Dry skin
  5. Confusion
  6. Fatigue
  7. Irritability
  8. Constipation
  9. Hypotension
  10. Orthostasis
  11. Tachypnea
  12. Tachycardia
  13. Oliguria
18
Q

What are the diagnostic studies for fluid loss?

A 
1. Hgb & Hct
A. Dehydration: up
B. Hypo: down
2. Serum osmolality
A. Dehydration: up
B. hypoV: down
3. Serum albumin
A. Dehydration: up
B. hypoV: equal or down
4. Urine SG
A. Dehydration: up
B. HypoV: equal or down
5. Serum Na
A. Dehydration: up
B. HypoV: Down
6. Central venous pressure (CVP)
A. Dehydration: down
B. hypoV: down by a lot
7. Pulmonary wedge pressures (PWP)
A. Dehydration:
B. HypoV:
19
Q

What does CVP measure?

A
  1. Direct measurement of BP in the right atrium & vena cava
    A. Normal CVP is 2-6 mm Hg
  2. Assesses right ventricular function & systemic fluid status
20
Q

Where does the CVP catheter measure the pressure?

A

Tip of central venous multi-lumen catheter rests in the lower 1/3 of SVC

21
Q

What is the pulmonary wedge pressure?

A
  1. Pressure measured by wedging a pulmonary catheter w/ inflated balloon into a small pulmonary arterial branch
  2. Provides indirect measurement ofleft atrialpressure
    A. Normal 2-15 mmHg
22
Q

What are the other names for pulmonary wedge pressure?

A
  1. Pulmonary arterial wedge pressure (PAWP)
  2. Pulmonary capillary wedge pressure (PCWP)
  3. Pulmonary venous wedge pressure (PVWP)
  4. Pulmonary artery occlusion pressure (PAOP)
23
Q

What is PWP used for?

A

Used to diagnose severity of LVF & mitral stenosis

24
Q

What is the gold standard for diagnosing acute pulmonary edema?

A
  1. PWP

A. PWP of >20mmHg indicates edema

25
Q

What are the implications of hypovolemia?

A
  1. Decreased cardiac output
  2. Ineffective tissue perfusion
  3. Deficient fluid volume
26
Q

What are the complications of hypovolemia?

A

Hypovolemic Shock

Vital organ hypoxia

27
Q

What is over hydration?

A

Water replacement w/out electrolyte replacement

28
Q

What is hypervolemia?

A
  1. Chronic stimulus to kidneys to conserve Na & water
  2. Abnormal renal function/renal failure
  3. Fluid shifts from interstitium to plasma
  4. Excessive Na intake
29
Q

How does the body compensate for excess body fluid?

A
  1. Increase release of natriuretic peptides
    A. ↑ Na & water loss by kidneys
    B. ↓ aldosterone release
30
Q

What are the sxs of hypervolemia?

A
  1. Confusion
  2. SOB
  3. Orthopnea
  4. Tachycardia
  5. HTN
  6. Edema
  7. Weight gain
  8. Crackles/rales
  9. JVD
31
Q

What are the dx studies for overhydration?

A
  1. Overhydration
    A. ↓ Hb & Hct
    B. ↓ Serum osmolality
    C. ↓ Serum Na
32
Q

What are the dx studies for hypervolemia (renal)?

A
  1. ↑ Lytes
  2. ↑ BUN Creatinine w/ CKD
  3. BNP
    A. less than 100 pg/mL suggests cardiac cause is unlikely
33
Q

What are the implications of hypervolemia?

A
  1. Impaired gas exchange
    A. Hypoxia
  2. Excess fluid volume
  3. Impaired skin integrity
34
Q

How is hypervolemia treated?

A
  1. Monitor ABG’s for hypoxemia & respiratory alkalosis
  2. Continuous PaO2
  3. Telemetry
  4. Administer oxygen as needed
  5. Administer loop diuretics
  6. Monitor daily I & O
  7. Limit fluids & Na
35
Q

What are the complications for hypervolemia?

A
  1. Pulmonary Edema

A. Ascending crackles, dyspnea at rest, confusion

36
Q

How is Pulmonary edema treated?

A
  1. IV Morphine
  2. IV Diuretic
  3. Prepare for possible intubation & mechanical ventilation

Gen Med: Surgery (6 decks)

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